مطالبات التأمين ضد إصابات العمال

TSGLI is a form of insurance coverage created to compensate military service members who were traumatically injured while serving in the military – regardless of whether their injury occurred while on-duty or off-duty. TSGLI is considered a rider to SGLI (Servicemember Group Life Insurance) and many servicemembers are unaware that this coverage was included in their SGLI premiums. If you paid for SGLI during your time spent in the military, and you suffered a significant injury, you may be eligible for compensation up to $100,000.

 

هل أنا مؤهل للحصول على TSGLI؟

قد تكون مؤهلاً للحصول على تعويض TSGLI إذا كنت مؤمنًا من قبل TSGLI وتعرضت لإصابة رضحية في 7 أكتوبر 2001 أو بعده ، وتفي بجميع المتطلبات المذكورة أدناه.

All of the following must be true:

  1. You have a scheduled loss that is a direct result of the traumatic injury, و
  2. You suffered a traumatic injury before midnight on the day you left the military, و
  3. You suffered a scheduled loss within 2 years (730 days) of the traumatic injury, و
  4. You were an active-duty military member, a Reservist, a National Guard member, on funeral-honors duty, or on 1-day muster duty.
 

من الذي يشمله TSGLI؟

Service members who were covered by TSGLI at the time of the injury and were serving in any one of the following capacities:

  1. الخدمة الفعلية
  2. تكريم الجنازة واجب
  3. الحرس الوطني
  4. واجب التجمهر ليوم واحد
  5. حجز
 

هل تغطي TSGLI الإصابات التي تحدث خارج الخدمة؟

Yes. TSGLI may cover injuries that occurred while on duty or خارج الخدمه.

 

ما أنواع الإصابات التي يغطيها TSGLI؟

  1. بتر 4 أصابع في يد واحدة أو الإبهام وحده
  2. بتر جميع أصابع القدم ، بما في ذلك إصبع القدم الكبير على قدم واحدة
  3. بتر إصبع القدم الكبير فقط ، أو 4 أصابع أخرى على قدم واحدة
  4. بتر اليد
  5. الحروق.
  6. Coma from Traumatic Injury and/or Traumatic Brain Injury (TBI) where the TBI results in the inability to perform at least two Activities of Daily Living (ADLs)
  7. إعادة بناء الوجه (الفك والأنف والشفتين والعينين وأنسجة الوجه)
  8. بتر القدم
  9. فقدان السمع
  10. الاستشفاء بسبب إصابات الدماغ
  11. Injuries to Men: Anatomical Loss of Penis, Permanent Loss of Use of Penis, Anatomical Loss of One Testicle, Anatomical Loss of Both Testicles. Additionally, permanent Loss of Use of Both Testicles, permanent loss of urinary system function
  12. إصابات النساء: الفقدان التشريحي للرحم أو الفرج أو القناة المهبلية ، الفقدان التشريحي لمبيض واحد. بالإضافة إلى ذلك ، فقد تشريحي لكلا المبيضين ، وفقدان دائم لاستخدام كلا المبيضين ، وفقدان كلي ودائم لوظيفة الجهاز البولي
  13. إنقاذ أطراف الذراع
  14. إنقاذ أطراف الساق
  15. فقدان القدرة على الكلام
  16. فقدان البصر
  17. شلل النصف السفلي
  18. الشلل الرباعي
  19. أحادي
 

هل أي إصابات مستثناة من TSGLI؟

Yes. To qualify for TSGLI, your injury cannot:

  1. Be self-inflicted, on purpose or the result of an attempt at self-injury, or
  2. Involve the use of an illegal drug or controlled substance taken in any manner inconsistent with the advice of a medical doctor, or
  3. تكون نتيجة العلاج الطبي أو الجراحي لمرض أو مرض ، or
  4. يحدث أثناء ارتكاب أو محاولة ارتكاب جناية ، or
  5. Be the result of a physical or mental illness or disease (not including illness or disease caused by a wound infection; a chemical, biological, or radiological weapon; or accidental ingestion of a contaminated substance).
 

هل هناك أنواع أخرى من المطالبات تنطبق أيضًا؟

Yes. Service members can file a claim related to the Loss of Activities of Daily Living (ADLs). A service member is considered eligible if the member is unable to independently perform at least 2 of 6 ADLs listed below. The inability must last at least 30 consecutive days. Generally speaking, inability means that the service member requires assistance to safely perform the activity as a result of the injury.

ما هي ستة (6) ADLs؟

  1. الاستحمام
  2. كبح الشهوة
  3. الضماد
  4. الأكل
  5. المرحاض
  6. نقل
 

What can I expect from filing a TSGLI claim?

Compensation can range from a baseline of $25,000 to a maximum of $100,000 (per traumatic event), depending on the specific details of your injury. This is meant to provide short-term monetary support to help you recover from your traumatic injury.

 

هل تتعامل شركتك مع طعون TSGLI على أساس طارئ؟

Yes. We charge no fee or costs until you recover.

 

How do I know if I have this benefit?

Since TSGLI is an automatic rider to full-time SGLI coverage, anyone who was signed up for SGLI should be covered. As long as your injury occurred while you were signed up with SGLI, there should be no issues in qualifying for this benefit.

 

ما زلت أتساءل ما الذي يعتبر مطالبة TSGLI؟

Below are nine examples of cases which would qualify for TSGLI compensation, followed by two examples of cases which would not qualify. To determine if you have a TSGLI claim contact us today at (800) 277-1193 . It won’t cost you anything unless we are successful in obtaining compensation for you.

يغطيها TSGLI:

Example 1: A service member’s vertebra is fractured in a mortar blast in Iraq. While undergoing surgery for the fractured vertebrae, a blood clot forms, causing the service member to be paralyzed from the waist down. The service member’s loss would be covered by TSGLI.

Example 2: A service member is injured in a motor vehicle accident. She suffers injuries to her leg. Unfortunately, her wounds develop a pus-forming infection (pyogenic infection) and gangrene spreads up her leg, resulting in amputation. The service member’s loss would be covered by TSGLI.

Example 3: While serving in Afghanistan, a service member is hit with materials from a chemical weapon. He develops an illness that causes the deterioration of his retinas, resulting in permanent vision loss. The service member’s loss would be covered by TSGLI.

Example 4: A service member is accidentally exposed to radiation while working at an Army weapons depot. The service member subsequently develops cancer and has to have his leg amputated. The service member's loss would be covered by TSGLI.

Example 5: A service member serving in Iraq is involved in a skirmish with enemy forces. He is forced to wait out the enemy for three days in a remote area. He only has a one-day supply of water. In order to survive, he drinks water from a small stream nearby. After escaping from his hiding place, the service member returns to base and becomes ill with vomiting, diarrhea, and a fever. After a few days of these symptoms, the service member falls into a coma for 20 days. It is determined that contaminated water from the stream caused the illness which then caused the coma. The service member’s loss would be covered by TSGLI.

Example 6: A service member is injured when his motorcycle slides on a wet road. He has deep skin abrasions, termed road rash, on his arms and legs. He undergoes wound care at a local Burn Center. He is unable to perform bathing and dressing for 30 days after his accident. The service member does not qualify for payment related to the burns, but does qualify for $25,000 for the inability to perform two ADLs for 30 days.

Example 7: A service member goes into a coma as the result of a military motor vehicle accident. The service member recovers from the coma 60 days later. The service member’s loss would be covered by TSGLI.

Example 8: A service member is injured in an automobile accident on March 1. She is taken to a local trauma center and is admitted. On March 6, her condition is stabilized and she is transferred to another hospital. She is released from the second hospital on March 17. She has accrued 15 consecutive hospitalization days (March 1-15) and would be paid a $25,000 TSGLI benefit.

Example 9: A service member is injured in a car accident on March 1. He is hospitalized from March 1 to March 12 but, due to his injuries, he is unable to perform the ADLs of bathing and dressing from March 1 to March 30. He regains his ADL on March 31. Due to complications, he is hospitalized a month later from May 1 to May 15. The service member will receive a $25,000 benefit for loss of ADLs for 30 days. He will not be paid for the subsequent 15-day hospitalization. Payment is made for either the 15-day hospitalization OR the first ADL milestone, whichever occurs first, not both.

لا يغطيها TSGLI:

Example 1: A service member goes to the hospital for a routine colonoscopy. Due to a medical error, the patient is injured and must remain in the hospital for 15 days. The service member’s loss would not be covered by TSGLI.

Example 2: A service member has diabetes which begins to cause problems to her foot, ultimately resulting in the amputation of her leg. The service member’s loss would not be covered by TSGLI because it was the result of treatment for an existing condition.

 

تواصل معنا

في الاتصال بنا للحصول على سرية مجانا التشاور، يمكنك الاتصال بنا على (850) 435-7000 or (800) 277-1193. يمكنك أيضًا طلب استشارة سرية من خلال النقر مجانا وسري استشارة، والتي سيتم مراجعتها فورًا بواسطة أحد محامينا.